New Residential Account Application

In compliance with the Fair Accurate Credit Transactions Act (FACTA), and the Columbia River People Utility District’s (PUD) Identity Theft Prevention Program, customers are required to provide their valid social security number at the time of this application.

We may access information on your credit report with the Credit Bureaus. Late payments or other defaults on your PUD account may be reflected on your credit report.

Opening an account constitutes an agreement to be financially responsible for the cost of all utility services provided at this location, at the applicable and established rates, and to be governed by the Columbia River PUD’s General Terms and Conditions. For a complete explanation of your rights and responsibilities, please refer to the Terms and Conditions, which can also be found in our office at 64001 Columbia River Highway, Deer Island, OR 97054.

Regular service hours are 7:00 a.m. to 4:30 p.m., Monday - Thursday, excluding holidays. Requests to stop service are typically processed within one business day.

Date Format: MM slash DD slash YYYY

Service Address*

Street AddressUnit NumberCityStateZIP Code

Residence Type*

Own/Buying

Renting

If Renting, Owner's Name & Phone Number

If Renting, Name(s) on Lease

Deposit Requirement*

Full deposit required at the time of service

Half of the deposit required at the time of service & AutoPay setup completed within 15 days

I am requesting my credit score be pulled & if my score is 700 or higher, my deposit will be waived. (I understand that if my credit score is not 700 or higher I will be required to select one of the alternate deposit requirements.)

Mailing Address (if different from Service Address)

Street AddressUnit NumberCityStateZIP Code

Phone*

Email*

I prefer to be contacted by:

Phone

Email

Social Security #*

Date of Birth*

Date Format: MM slash DD slash YYYY

Co-Applicant's Full Legal Name

Please provide middle initial.

FirstMiddleLast

Co-Applicant's Mailing Address

Street AddressUnit NumberCityStateZIP Code

Co-Applicant's Social Security #

Co-Applicant's Date of Birth

Date Format: MM slash DD slash YYYY

Authorization
I am requesting utility service at the above indicated location. By completing this form, I agree to be financially responsible for the cost of all utility services provided at this location until I close the account. Only those persons listed on the account can receive account details. To authorize others access to your account information, please call our office at (503) 397-0590. Failure to receive mail or an electronic bill does not release you from payment obligations. A Security Deposit may be required. In its sole discretion, the PUD may require at any time a Deposit as a guarantee of performance by the customer (delinquent account, high usage, etc.). The PUD may disconnect Electric Service for failing to pay for services rendered, tampering with PUD meters, connections or other equipment, diverting service, committing fraud, or theft of Electric Service. Refer to the General Terms and Conditions for complete explanation.

Applicant Signature*

By typing my name below, I am acknowledging that I have consented to receive automated phone calls and/or text messages, that I understand this application for service, and that I affirm the above information is correct to the best of my knowledge: